


<%@ include file="/includes/header_public.html"%>
    	<ul class="hm_links">
            	<li><a href="/index2.jsp">HOME</a></li>
                <li><a href="#">ABOUT ATSOCII</a></li>
                <li><a href="#">INDUSTRY NEWS</a></li>
                <li><a href="#">CUSTOMER SUPPORT</a></li>
        </ul>
	
<div class="home_middle" style="margin-left:350px;">
	<div id="rightside" >
		<article>
    	<header><h2>User Registration Form </h2></header>
        <div class="group" id="createDiv">
            <div class="lblDiv">Full Name: <span>*</span></div>
            <div class="cntrlDivBig">
            	<select name="" id="reg_salutation" class="small_ddl">
                	<option value="">Mr.</option>
                    <option value="">Miss</option>
                    <option value="">Dr.</option>
                </select>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input type="text" name="" id="fname"  placeholder="First Name" />&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input type="text" name="" id="lname" placeholder="Last Name" />
                <span id="fname_error" style="color:red"> </span>
            </div>
            <div class="lblDiv">E-mail: <span>*</span></div>
            <div class="cntrlDiv"><input type="text" name="" id="username" /><span id="username_error" style="color:red"></span>
            <span id="username_avl_status" style='color:red;'> </span></div>
            <div class="lblDiv">Confirm E-mail: <span>*</span></div>
            <div class="cntrlDiv"><input type="text" name="" id="username_confirm" />  <span id="username_confirm_error" style="color:red"></span></div>
            <div class="lblDiv">Password:</div>
            <div class="cntrlDiv"><input type="password" name="" id="password" /> <span id="password_error" style="color:red"></span></div>
            
            <div class="lblDiv">Confirm Password: <span>*</span></div>
            <div class="cntrlDiv"><input type="password" name="" id="conf_password" />  <span id="conf_password_error" style="color:red"></span></div>
           
          
            <div class="lblDiv">Address: <span>*</span></div>
            <div class="cntrlDivBig"><input type="text" class="txtBoxBig" name="" id="addr_line1" placeholder="Street Address" /> <span id="addr_line1_error" style="color:red"></span></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDivBig"><input type="text" class="txtBoxBig" name="" id="addr_line2" placeholder="Street Address Line 2" /></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDivBig"><input type="text" class="txtBoxBig" name="" id="addr_line3" placeholder="Street Address Line 3" /></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDiv"><input type="text" name="" id="city" placeholder="City" /><span id="city_error" style="color:red"></span></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDiv"><input type="text" name="" id="state" placeholder="State / Province" /> <span id="state_error" style="color:red"></span></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDiv"><input type="text" name="" id="zip" placeholder="Postal / Zip Code " /><span id="zip_error" style="color:red"></span></div>
            <div class="lblDiv">&nbsp;</div>
            <div class="cntrlDiv">
            	<select name="" id="country">
                	<option value="">Select Country</option>
                    <option value="">United States</option>
                    <option value="">Others</option>
                </select>
            </div>
            <div class="lblDiv">Phone Number:</div>
            <div class="cntrlDiv">
            	
            	<input type="text" class="txtBoxTiny" name="" id="areaPhone" placeholder="Area" /> - 
                <input type="text" class="txtBoxSmall" name="" id="phoneNumber" placeholder="Phone Number" />
            </div>
            <div class="lblDiv">FAX:</div>
            <div class="cntrlDiv">
            	
            	<input type="text" class="txtBoxTiny" name="" id="areaFax" placeholder="Area" /> - 
                <input type="text" class="txtBoxSmall" name="faxNumber" id="" placeholder="Fax Number" />
            </div>
            <div class="halfDiv">
            	<div class="lblDiv">Delivery<br/>Information:</div>
                <div class="cntrlTextarea"><textarea name="" id="deliveryNote"></textarea></div>
            </div>
            <div class="halfDiv">&nbsp;</div>
            <div class="btnDiv">
            	<div class="lblDiv">&nbsp;</div>
            	<div class="cntrlDivBig">
            	<input type="checkbox" id="term_conditionFlag" onclick="tn_regToggle();"> 
         		I have read and I accept All <a href="javascript:void(0);" onclick="javascript:reg_openTnc();">Terms and Conditions</a> associated for my membership.
         	<br><input id="registerButton" onclick="tn_registerUser();" disabled="disabled"  type="submit"  value="Register">
         	</div>
         </div>
     </div>
		</article>
  </div>
 </div>  
    
    
<div class="claer_div"></div>

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<script type="text/javascript" src="../scripts/register.js"></script>
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